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INTRODUCTION AND IMPORTANCE: D-wave (Direct waves) are Motor Evoked Potentials (MEPs) generated by a single transcranial stimulation and captured by attaching an epidural recording electrode caudal to the vulnerable area. Intraoperative neurophysiologic monitoring (IONM) is widely used in neurosurgery to recognize important neurological structures but can be challenging in the pediatric population due to incomplete neural development. CASE PRESENTATION: Case 1: A 48-year-old female presented to the outpatient department with complaints of difficulty walking for the past six months, numbness and weakness in bilateral lower limbs with recurrent falls for the past 1 month. Case 2: A 12-year-old boy presented to the emergency room with a history of inability to use both upper and lower limbs on the right side with tremulousness. CLINICAL DISCUSSION: Magnetic resonance imaging (MRI) Spine in the first case revealed a D9-D10 calcified meningioma with significant spinal cord compression. In the second case, MRI Spine showed C1-C2 Intramedullary Space Occupying Lesion (SOL) and was planned for C1-C2 laminectomy with midline myelotomy. The first case was planned for microsurgical excision of the lesion under IONM guidance. The procedure went smoothly. Microsurgical gross total resection (GTR) of the intramedullary SOL under IONM Guidance was done for the second case. Postoperatively, the first patient showed no neurological compromise or complications. In the second case, following surgery, the child recovered gradually from surgery. CONCLUSION: This case series demonstrates the successful surgical management of two cases of spinal cord tumors through an IONM-guided surgery and the effective use of D waves in such challenging cases.
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As of 3rd June 2022, 445 cases of monophasic Salmonella Typhimurium sequence type 34 infection had been reported globally. The outbreak was caused by two novel strains of monophasic S. Typhimurium with unusual multi-drug resistance. The majority of these cases involved children aged 10 or younger, and they had a hospitalization rate higher than most previous outbreaks of monophasic S. Typhimurium, but no fatalities were recorded. The infection was traced to certain Belgian chocolate products after extensive microbiological and epidemiological research. Public health officials took immediate action to recall all the contaminated products, and the risk of exposure was reduced. The common symptoms are bloody diarrhea, acute onset of fever, abdominal pain, and vomiting. This article aims to thoroughly review the recent outbreak of monophasic Salmonella Typhimurium ST-34, including its epidemiology and comparison with ongoing outbreaks. We also highlighted past chocolate-related salmonella outbreaks and current control and prevention guidelines and recommendations.
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â¢Currently natural lifestyle modification is recommended over bariatric surgery in the management of infertility in obese men and women, despite natural weight loss often being an ineffective method to both lose and maintain weight loss in these individuals.â¢Through this meta-analysis and systematic review, we provide evidence that bariatric surgery effectively improves fertility outcomes for men and women by measurements of hormone levels and improvements in sexual function index scores.â¢This study demonstrates the importance and even cruciality of bariatric surgery in obese men and women who struggle with reproductive health, especially when finding it difficult to lose and maintain weight. It also proves that it is vital to continue to create and expand our knowledge with evidence-based medicine to help this cohort of patients.
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The rise in the cases of acute hepatitis of unknown aetiology in the paediatric population is a public health concern worldwide and investigations to ascertain the exact cause of this outbreak are being carried out extensively by the concerned authorities. In early April 2022, the World Health Organisation (WHO) issued a warning on acute hepatitis of unknown origin in children. Since then, there have been continuing additional reports of the cases globally. The recent cases of acute hepatitis of unknown aetiology are more prevalent in children aged <10 years, are more clinically severe, and a high percentage of infected individuals develop acute liver failure in contrast to the previous cases. The aetiology of this disease and its complete pathogenesis is still unclear. This review critically focuses on the current leading hypothesis and provides comprehensive information regarding this recent outbreak that can help in handling the situation by a better understanding of its aetiology.
